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

Premature Birth Attorneys & Cerebral Palsy Lawyers

When a baby is born prematurely – or about to be born prematurely – physicians must make every effort to prevent the serious problems associated with preterm birth, such as respiratory distress, sepsis, brain bleeds (especially intraventricular hemorrhages (IVH)) and periventricular leukomalacia (PVL).  When a baby is less than 34 weeks of gestation and the physician suspects she will be born soon, corticosteroids should be given to the mother to help the baby.  Betamethasone is the most commonly used steroid, and it has been shown to reduce the incidence and severity of respiratory distress syndrome (RDS), IVH, sepsis and PVL.  When appropriately given to the mother, Betamethasone helps the baby’s lungs mature before the baby is delivered.  The drug also helps numerous tissues throughout the baby’s body mature and it improves circulatory stability in preterm babies.  Indeed, Betamethasone should be given even if there is a risk of premature birth.  If the baby isn’t born as soon as the physician had expected, Betamethasone therapy should usually be repeated.  Even a few minutes of corticosteroid therapy is beneficial for the baby.

RDS, sepsis, intraventricular hemorrhages (IVH) and periventricular leukomalacia (PVL) can cause a child to have cerebral palsy, seizures, intellectual disabilities and developmental delays.

Indeed, premature birth greatly increases a baby’s risk of having birth injuries.  Physicians are required to recognize risk factors for premature birth and diagnose preterm labor, and they must follow standards of care to prevent premature birth.  This may include administration of medications to do the following:

  1. Stop contractions (terbutaline and brethine)
  2. Mature the baby’s lungs (betamethasone in-utero and surfactant after birth)
  3. Prevent infection
  4. Provide the baby with protection from brain damage (magnesium sulfate).  Sometimes a cervical cerclage (a stitch in the cervix) is placed at or before week 24 of pregnancy or the mother is given progesterone therapy in order to help prevent preterm birth.


Betamethasone leads to improvement in a baby’s lung function by speeding up maturational changes in lung architecture (and other tissues) and by enhancing production of lung enzymes involved in respiratory function.  These changes improve lung compliance and lung volume as well as gas exchange, meaning the baby can more easily take in oxygen and get rid of carbon dioxide (CO2).  Improved maturity of lung and other body tissues, improved oxygenation and ventilation, and improved circulatory stability are the main effects of betamethasone that help prevent serious injury in the baby, such as RDS, IVH, PVL and sepsis.


Betamethasone is very important for a baby who is about to be born preterm.  Once the baby is born, another drug should be given to help her lungs mature and prevent respiratory distress syndrome and associated complications.  This drug is called surfactant.  Premature lungs often lack surfactant, which is a lipoprotein the lungs produce to help the lungs be more compliant.  Surfactant helps prevent the airways (alveoli) form collapsing at the end of exhalation, and it also helps recruit the airways that have collapsed.  When the baby has insufficient surfactant, her lungs will be stiff and there can be a lot of collapsed airways.  This can make it very difficult for the baby to breathe, even if she is on a breathing machine (ventilator).  Stiff lungs on a ventilator can become seriously injured.  In addition, babies with stiff lungs and respiratory distress are prone to getting lung infections and pneumonia.  Stiff lungs, collapsed airways and infection can cause the baby to suffer from a lack of oxygen to her brain, which can cause hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL) and cerebral palsy.  If the baby is born before 35 weeks she will likely require surfactant therapy.

One area of medical negligence commonly seen is failure to properly treat respiratory distress, apnea, hypoxia (baby not getting enough oxygen) and acidosis (acidic blood).  Apneic events, long term hypoxia and acidosis can cause permanent brain damage, such as hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL) and cerebral palsy.  Respiratory distress can also cause long-term hypoxia and acidosis, and it is associated with apnea.  Sometimes the medical team wants to avoid putting a tube in the baby’s upper airway and putting her on a ventilator due to the risks they think intubation and mechanical ventilation pose.  The baby then doesn’t get enough help with her breathing.  With proper management, however, the risks of intubation and being on a ventilator are minimal.  The consequence of not treating apnea, hypoxia and acidosis is potential permanent brain damage.

Indeed, we have seen cases in which a baby has numerous documented episodes in which she stops breathing, her heart beat becomes really slow, the oxygen level in her blood drops, and she turns dusky or blue and has to be stimulated to breathe again, with many of the apneic events lasting for one or more minutes.  This apnea can last for a week or much longer.  Sometimes the physicians think that a baby will outgrow the apnea, and that often happens.  But that is no excuse for letting a baby suffer periods of oxygen deprivation and a very slow heart rate (bradycardia), which can cause permanent brain damage such as hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL) and cerebral palsy.

Proper management of a premature baby’s breathing is crucial.  Betamethasone should be given in-utero, surfactant should be given after birth, and if the baby needs help breathing, the medical team should give her all the support she needs.  Ventilatory and respiratory support require continuous monitoring of the baby’s status, with adjustments being made as needed.


Sometimes, settings on the baby’s ventilator are so high that the baby gets rid of too much CO2, which is called hypocarbia.  Abnormally low CO2 levels are often overlooked in the hospital, but even a few hours of low a low CO2 level can cause permanent brain damage such as periventricular leukomalacai (PVL) and cerebral palsy.  It is very important for the medical team to pay close attention to a baby’s CO2 levels.  Certain factors, such as surfactant administration, can cause a baby’s lungs to become more compliant, which usually means she will be getting rid of more CO2 while on the ventilator.  In fact, a wide variety of factors can affect a baby’s CO2 level, and it is important for changes to be made to the ventilator very quickly if the baby’s CO2 level becomes low.  Hypocarbia is easy to correct by simple changes in the ventilator settings, and there is absolutely no excuse for prolonged hypocarbia.


Indeed, betamethasone, magnesium sulfate, surfactant and proper ventilation of a premature baby are crucial in the prevention of respiratory distress, intraventriculuar hemorrhages (IVH), sepsis, hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), and cerebral palsy.  But the best way to prevent these birth injuries is to prevent premature birth, which can often be accomplished with close prenatal monitoring, and indicated medical interventions, such as treatment of infections, administration of terbutaline or brethine, a cervical cerclage, and progesterone therapy.

Hypoxic ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL) are very serious brain injuries that often cause a child to have lifelong seizures and cerebral palsy.  Some children with also develop hydrocephalus.

Periventricular leukomalacia (PVL) is primarily seen in premature babies, although term babies can also develop PVL.  PVL consists of death and damage of the brain’s white matter, especially near the ventricles.  In some cases of PVL, fluid filled cysts are left behind when the white matter dies.

Hypoxic ischemic encephalopathy (HIE) can be caused by the same conditions that cause PVL (infection, hypoxia, ischemia (reduced or restricted blood flow in the brain), brain bleeds), but HIE typically consists of damage to the basal ganglia and/or the watershed regions of the brain.


Betamethasone: PREMATURE BIRTH & BIRTH INJURY ATTORNEYS HELPING CHILDREN WITH HIE, PVL & CEREBRAL PALSY FOR ALMOST 3 DECADESIf you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases.  Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for almost 3 decades.

Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy.  Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report, which also recognized the firm as being one of the best medical malpractice firms in the nation.  The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help.  We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case.  Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation.  Our firm’s award winning lawyers are available 24 / 7 to speak with you.


  • Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; :CD004454.
  • Mendelson CR, Boggaram V. Hormonal control of the surfactant system in fetal lung. Annu Rev Physiol 1991; 53:415.
  • Smolders-de Haas H, Neuvel J, Schmand B, et al. Physical development and medical history of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome: a 10- to 12-year follow-up. Pediatrics 1990; 86:65.
  • Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol 1995; 173:254.
  • Polk DH, Ikegami M, Jobe AH, et al. Preterm lung function after retreatment with antenatal betamethasone in preterm lambs. Am J Obstet Gynecol 1997; 176:308.
  • Vidaeff AC, Ramin SM, Gilstrap LC 3rd, Alcorn JL. In vitro quantification of dexamethasone-induced surfactant protein B expression in human lung cells. J Matern Fetal Neonatal Med 2004; 15:155.
  • Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J Obstet Gynecol 1995; 173:322.
  • Gates S, Brocklehurst P. Decline in effectiveness of antenatal corticosteroids with time to birth: real or artefact? BMJ 2007; 335:77.
  • Report on the Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. U.S. Department of Health and Human Services, Public Health Service, NIH Pub No. 95-3784, November 1994.
  • Smith LM, Altamirano AK, Ervin MG, et al. Prenatal glucocorticoid exposure and postnatal adaptation in premature newborn baboons ventilated for six days. Am J Obstet Gynecol 2004; 191:1688.