Efficacy of a single dose of antenatal steroid in surfactant-treated babies under 31 weeks' gestation

Antenatal steroids in labor improve the outcome in preterm babies. The objective in this retrospective study was to compare the efficacy of one dose of antenatal steroid against the standard course in surfactant-treated babies.

A total of 226 babies treated with prophylactic surfactant and under 31 weeks' gestation were divided into three groups: group 1 (n = 89), no antenatal steroids; group 2 (n = 68), one dose of antenatal steroids 4-24 h before delivery; and group 3 (n = 69), two or more doses of antenatal steroids 24 h to 7 days before delivery. The three groups were compared for early clinical well-being and ultimate clinical outcome.

Apgar and Clinical risk index for babies (CRIB) scores in groups 2 and 3 were similar and both were significantly better than in group 1. Group 2 babies had a 23.5% reduction in serious intraventricular hemorrhage (IVH) (p < 0.0001, relative risk (RR) 0.2 (95% CI 0.07-0.54), numbers needed to treat (NNT) 4.6) and a 22.9% reduction in death (p < 0.001, RR 0.28 (95% CI 0.12-0.63), NNT 4.4) and group 3 babies had a 21.1% reduction in IVH (p < 0.001, RR 0.25 (95% CI 0.10-0.62), NNT 4.6) and a 24.2% reduction in death (p < 0.001, RR 0.23 (95% CI 0.10-0.57), NNT 4.2) compared to group 1. For these parameters, there was no significant difference between groups 2 and 3.

One dose of antenatal steroids given 4-24 h before delivery was clinically comparable to the recommended schedule of the National Institutes of Health in surfactant-treated preterm infants. Should the findings of this study be confirmed in randomized controlled trials, the dosage regimen could be simplified, steroid administration reduced and the interval from delivery reduced in acute clinical conditions.