93: Steroids to enhance fetal lung maturity: How do obstetricians prescribe?

Abstract

To study the practices of steroid use for fetal lung maturity among Lebanese obstetricians and assess their compliance with current recommendations. Questionnaires that solicited practice patterns of steroid use for enhancing fetal lung maturity were mailed to a random sample of Lebanese obstetricians (n=175). Descriptive statistical methods were used to evaluate the responses. Questionnaires were returned by 149 physicians (85.1%). 99.3% of responders use steroids routinely in the context of preterm labor and 74.7% use it with preterm rupture of the membranes. NIH recommended doses are used by 43.6% of physicians; 49% use 12 mg betamethasone every 12 hrs. Whereas 96.6% believe that steroids have a strong positive effect on respiratory distress syndrome (RDS), 22.8%, 34.1% and 60.4% believe it has such an effect on necrotizing eneterocolitis, intraventricular hemorrhage, and mortality, respectively. Of responders, 24.8% do not repeat, 66.4% sometimes repeat and 8.8 % always repeat the courses, mostly for twin gestations or extreme prematurity. If courses are repeated, an extra course is given by 36.6% whereas multiple courses are given by the rest; 14.3% would continue till 34 weeks. 51.8% repeat courses weekly and 23.2% repeat every other week. The obstetrician¡−s major concerns for repeating courses are the need for more safety data and fear of infection. Almost half responded that they are aware of recent prospective trials about steroids: 47.9% believe that those studies are in favor of repeat courses which are associated with a lower risk of RDS and 27.1% believe that results are conflicting. A significantly larger proportion of obstetricians <50 years of age are aware of new literature (63.0% vs 32.4%, P<0.001) and prescribe the correct formulation (51.8% vs 30.9%, P=0.016) compared with those ≥50 years. In a representative sample of Lebanese obstetricians, 50% of responders are aware of new literature regarding steroids and only 25% are compliant with the current recommendations of single course of steroids.