Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation

Abstract

APRETERM BIRTH OCCURS IN 10% of all live births and is a major cause of neonatal mortality and morbidity. In preterm infants, survival is strongly related to gestational age (GA). Antenatal corticosteroid therapy for fetal maturation is one of the most effective ways to improve the outcomes of preterm births. Randomized controlled trials conducted between 1972 and the early 1990s confirm benefit in most populations. Antenatal corticosteroid therapy reduces the risk of infant mortality by approximately 30%, of neonatal respiratory distress syndrome by approximately 50%, and of both intracranial hemorrhage and periventricular leukomalacia by approximately 70%. The latter 2 conditions are among the best predictors of long-term neurodevelopmental injury, including cerebral palsy. Net economic benefits are estimated at more than $3000 per treated neonate. Despite evidence of its effectiveness, use of corticosteroid therapy in eligible infants remained relatively low through the 1990s. Of particular importance, the therapy was used less often when GA was less than 28 weeks, compared with GA between 28 and 34 weeks. Yet these very low-GA infants were precisely the group that would most likely benefit from antenatal corticosteroids. Because of these discrepancies, the National Institutes of Health (NIH) with its affiliate, the National Institute of Child Health and Human Development (NICHD), convened a consensus panel in February 1994 to develop practice recommendations for antenatal corticosteroid therapy. The panel concluded that nearly all women who are between 24 and 34 weeks of their pregnancies and are likely to deliver preterm are candidates for the therapy. In this article, we report results of a randomized controlled trial comparing changes in the use of antenatal cortico-