Antenatal corticosteroids for the prevention of neonatal respiratory distress in a predominantly rural state medicaid population

Abstract

Objective: To examine the use of prenatal intramuscular steroids in a community setting as outlined in National Institutes of Health (NIH) guidelines to reduce respiratory distress syndrome in premature infants. Methods: We performed a complete chart review for 1 year of deliveries to Medicaid mothers at 25–34 weeks’ gestation at all obstetric units in Arkansas, analyzing time of arrival to the hospital, time of delivery, and dosage, and route of steroid administration to compare processes between community and teaching center sites, and general performance with NIH guidelines. Results: Of 191 deliveries at 25–34 weeks’ gestation, 63.4% of mothers received at least one dose of corticosteroids before delivery. Only 124 (65%) of these mothers presented to the hospital more than 4 hours before delivery and 87% of these mothers received at least one dose of corticosteroids before delivery. Ninety percent of women who were transferred after presenting in labor and 94.9% of women who delivered at the tertiary care referral center received corticosteroids. There was no statistically significant difference in corticosteroid administration rates for women with or without preterm premature rupture of membranes. Many women received corticosteroids at dosages and intervals disparate with NIH guidelines. Conclusion: Obstetric providers in Arkansas administered antenatal steroids to Medicaid women in preterm labor at a rate higher than stated in previous literature. Delivery at a nonreferral center or within 4 hours of arrival to the hospital were associated with reduced antenatal corticosteroid administration. Improved performance efforts should target institutional usage and behavior of mothers at risk for premature delivery.