Single vs multiple courses of steroids for fetal maturation: Is more better?

OBJECTIVE: To determine if perinatal outcome is improved in patients receiving >1 complete course of steroids vs a single course. STUDY DESIGN: We conducted a retrospective cohort study of 102 patients receiving a single course of antenatal steroids and 62 patients receiving >1 course of antenatal steroids who delivered at 24-34 weeks. All patients were delivered between 24 hours to 7 days after the steroids were administered. Singleton and multiple gestations were analyzed separately. The data was also analyzed in a subset of patients delivered at 24-30 weeks. The gestational age at delivery was similar in both groups. RESULTS: There were no significant differences in neonatal outcomes overall between the 2 groups. However, there was a significant reduction in RDS in the subset of singletons delivered at 24-30 weeks as shown below. Single course steroids ≥2 courses p-value (n = 38) (n = 13) RDS (%) 46.7 0 0.02 Pneumothorax (%) 20.0 12.5 NS O2 >28 days 20.0 0 NS IVH 40.0 62.5 NS For multiple gestations a trend toward reduction in RDS from 50% to 27% (p = 0.08) was seen in patients receiving multiple steroids. CONCLUSION: Multiple courses of steroids may decrease the incidence of RDS compared to a single course in the very preterm infants and in multiple gestations.