Date of Award
Master of Physician Assistant Studies
Physician Assistant Education
Although it is well-known that the administration of antenatal corticosteroids to mothers at risk of preterm birth improves outcomes in premature infants, premature births and associated morbidity and mortality are still prevalent. Typical mortality associated with premature births account for approximately one-third of all infant deaths in the United States. Infants born before 25 weeks gestation have the highest mortality rate, and if they survive, are at the greatest risk for severe morbidity, which translate into higher risk of hospital readmission and significant medical costs. Premature neonates are at a higher risk for acute complications, including necrotizing enterocolitis, growth difficulties, sepsis, intracranial bleeding, retinal detachment, bronchopulmonary dysplasia, chronic lung disease, and death. In early childhood, morbidities include motor delay, cerebral palsy, lower IQs, behavior problems, respiratory illness, difficulty with school work, and lower health-related quality of life.
For those reasons, corticosteroid administration prior to anticipated preterm birth is one of the most important and effective antenatal therapies available to improve newborn outcomes. The American College of Obstetricians and Gynecologists (ACOG) currently recommends the administration of a single course of antenatal corticosteroids for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation at risk of preterm delivery within 7 days . A Cochrane meta-analysis concluded with a recommendation that a single course of antenatal corticosteroids should be given for all preterm deliveries . However, one study showed multiple courses of antenatal corticosteroids were associated with a lower incidence of respiratory distress syndrome (P=.005; odds ratio, 0.44; 95% confidence interval, 0.25-0.79), patent ductus arteriosus (20% vs 13%; P=.016), and mothers treated with multiple courses had a lower incidence of prolonged rupture of membranes (24% vs 33%; P=0.6) . This paper reviews whether a single course of antenatal corticosteroid therapy compared to multiple courses of antenatal corticosteroid therapy in preterm infants is necessary to prevent mortality and disability within 10 years. Multiple versus single courses of betamethasone and dexamethasone will be examined as it is prudent to prevent premature births and assess the long-term risks and benefits of antenatal corticosteroids.
Lee, Ellen K., "Long-term Outcomes of Single vs. Multiple Courses of Antenatal Corticosteroids in Mothers at Risk for Preterm Delivery" (2019). Physician's Assistant Program Capstones. 28.