471: Intended administration of antenatal late preterm steroids: Is a single dose enough?

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The need for expedited delivery prior to the second dose of late preterm corticosteroids (LPCS) is common in clinical practice. Our objective was to estimate the rate of neonatal respiratory support, stillbirth or death ≤72h after delivery in women receiving a single vs two doses of LPCS. Secondary analysis of a multicenter trial of LPCS for prevention of neonatal respiratory morbidity and mortality. All women intended for LPCS and received either 1 or 2 doses at 34 0/7 to 36 6/7 wk were included for analysis. Major anomalies were excluded. Primary outcome was rate of neonatal respiratory support (CPAP or high- flow nasal cannula for at least 2 consecutive hrs, supplemental oxygen with FiO2 at least 0.3 for at least 4 continuous hrs, ECMO, or mechanical ventilation), stillbirth or death ≤72h after delivery. Secondary outcome was rate of respiratory distress syndrome (RDS). Multivariate logistic regression was performed for confounder control. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported for outcomes of interest. Of 1416 women meeting inclusion criteria, 561 (40%) received only a single dose of LPCS. Relevant baseline characteristics are shown in Table 1. Latency from randomization to delivery among those who received a single dose was shorter (26±84 vs 152±175 hrs). After logistic regression, the rate of neonatal respiratory support, stillbirth or death ≤72h after delivery was similar between those receiving 1 vs 2 doses (15 vs 10 %, aOR 1.41, 95% CI 0.96-2.08). Conversely, a single dose was not associated with lower rate of RDS (8 vs 4%, aOR 1.98, 95% CI 1.17-3.36). Other neonatal outcomes were similar between groups (Table 2). In women at risk for late preterm delivery, administration of single vs two doses of LPCS is associated with similar rates of neonatal respiratory support, stillbirth or neonatal death ≤72h after delivery; without decreasing the risk for RDS. This finding is relevant in appropriately selected women who require prompt delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)