Two Steroid Courses Safe After Preterm Membrane Rupture

Larry Hand

October 09, 2014

Two courses of antenatal corticosteroids can be administered to pregnant women with preterm premature rupture of membranes (PROM) without increasing the risk for neonatal sepsis, according to an article published online October 6 in Obstetrics & Gynecology.

Since 2000, the recommendation from the Eunice Kennedy Shriver National Institute of Child Health and Development has been to limit administration to a single course of steroids. However, the data supporting that recommendation are thin, according to Cynthia Guamfi-Bannerman, MD, and Moeun Son, MD, from the Department of Obstetrics and Gynecology at Columbia University Medical Center, New York City.

Therefore, they conducted a secondary analysis of data from the Maternal-Fetal Medicine Units study on magnesium for neuroprotection.

Of 2241 women in the parent study, 1641 had singleton pregnancies and preterm PROM and received one or two courses of corticosteroids, and were thus included in the current analysis. The145 women who received two courses of antenatal corticosteroids did not differ from those who received one course in terms of age, race, gestational age, and mode of delivery.

The researchers found that the rate of neonatal sepsis was not significantly different between the two groups of women, at 16.2% for women who received one course and 17.2% for women who received two courses of steroids. They also found no apparent difference in birth weight or rate of respiratory distress syndrome (RDS).

"[W]e found that ruptured membranes for more than 14 days, a lower gestational age at delivery, lower birth weight, and RDS were associated with neonatal sepsis," the researchers write. "These associations are well known, and before and after adjusting for these in our regression model, two courses of antenatal corticosteroids were not associated with neonatal sepsis."

In a separate article also published online October 6 in Obstetrics & Gynecology, Jane E. Brumbaugh, MD, from the Stead Family Department of Pediatrics at the University of Iowa, Iowa City, and colleagues describe a single-center study of neonates born between 2002 and 2011 after exposure to preterm PROM for 1 week or longer.

They found that the survival rate for neonates exposed to preterm PROM was not statistically different from that of neonates not exposed to preterm PROM (90% vs 95%, respectively). However, exposed neonates were more likely to have pulmonary complications.

"Our study expands the gestational age at rupture and latency for neonatal survival after preterm PROM in the era of antenatal corticosteroids, surfactant, and inhaled nitric oxide," the researchers write.

"Despite improved survival over the past two decades, neonates exposed to preterm PROM still require increased resources," they conclude.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online October 6, 2014. Gyamfi-Bannerman and Son abstract, Brumbaugh abstract

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