Published online October 26, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e835-e843 (doi:10.1542/peds.2009-0905)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Joseph, K. S. Articles by Vincer, M. J. PubMed PubMed Citation Articles by Joseph, K. S. Articles by Vincer, M. J. Related Collections Premature & Newborn Social Bookmarking                         What's this?

ARTICLE

Prenatal Corticosteroid Prophylaxis for Women Delivering at Late Preterm Gestation

K. S. Joseph, MD, PhD^a,b, Farrell Nette, MD^a, Heather Scott, MD^a and Michael J. Vincer, MD^b

Departments of ^a Obstetrics and Gynaecology and School of Population and Public Health, University of British Columbia and British Columbia's Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
^b Pediatrics, Dalhousie University and the Izaak Walton Killam Health Centre, Halifax, Canada

OBJECTIVE: We studied patterns of prenatal corticosteroid use, respiratory distress syndrome, and associated mortality rates to assess the congruence between knowledge and clinical practice related to such prophylaxis.

METHODS: We used data on all live births in the United States (for the years 1989–1991, 1995–1997, and 2002–2004) and Nova Scotia, Canada (for the years 1988–2007). Gestational age-specific temporal trends in infant deaths resulting from respiratory distress syndrome were quantified in the United States, and gestational age-specific temporal trends in corticosteroid use and morbidity (respiratory distress syndrome and intraventricular hemorrhage) were quantified in Nova Scotia.

RESULTS: In the United States, infant deaths associated with respiratory distress syndrome decreased by 48% (95% confidence interval: 46%–50%) from 1989–1991 to 1995–1997 and then decreased by another 18% (95% confidence interval: 15%–22%) by 2002–2004. The latter mortality reduction was evident at 28 to 32 weeks but not 33 to 36 weeks of gestation. Corticosteroid use at 28 to 32 weeks was high in Nova Scotia and increased from 30.7% in 1988–1989 to 50.0% in 1996–1997 and to 52.9% in 2006–2007, whereas rates of use at 33 to 36 weeks were much lower (eg, 6.7%, 17.0%, and 15.7% at 34 weeks in the 3 periods). Increased corticosteroid use at 33 and 34 weeks was estimated to reduce respiratory distress syndrome substantially.

CONCLUSION: Addressing the knowledge-practice gap in corticosteroid use at 33 to 34 weeks should reduce infant morbidity and mortality rates.

---

Key Words: prenatal corticosteroid treatment • respiratory distress syndrome • morbidity • mortality

Abbreviations: CI—confidence interval

---

Accepted Jun 9, 2009.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?