Increasing use of antenatal corticosteroid therapy between 1990 and 1993 in Vermont Oxford Network

The purpose of this study was to determine whether the frequency of antenatal corticosteroid treatment changed between 1990 and 1993 and to identify patient characteristics associated with the use of this treatment.

A total of 17,335 infants born in the years 1990 to 1993 with birth weights of 1500 gm or less and gestational ages of 24 to 34 weeks who were cared for at one of the 94 institutions participating in the Vermont Oxford Network were included in the study. Ninety-one infants were excluded from analysis because of missing data, resulting in a final sample of 17,244 infants.

The percentage of infants whose mothers received antenatal corticosteroid treatment increased steadily during the 4-year study period (19.3% in 1990, 24.8% in 1991, 28.6% in 1992, and 34.1% in 1993; p < 0.001 by chi square test for trend in proportions). The results of a logistic regression analysis indicated that increasing year of birth, inborn location of birth, prenatal care, and multiple birth were associated with an increased use of antenatal corticosteroid treatment; black race and small size for gestational age were associated with decreased use of the treatment. In 1993, the median percentage of infants at an individual institution whose mothers received antenatal corticosteroid treatment was 25%; 10% of institutions had percentages less than 7% and 10% had percentages higher than 60%.

Although the use of antenatal corticosteroid treatment increased steadily during the study period, this treatment was still used infrequently at many institutions in 1993. Considerable improvements in outcomes for preterm infants can be achieved if the recommendations of the National Institutes of Health Consensus Development Panel regarding more widespread use of antenatal corticosteroid treatment are adopted by health professionals who provide medical care to pregnant women.