A groundbreaking study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has demonstrated that partial administration of antenatal steroids can significantly benefit extremely preterm infants, even when given just hours before delivery.
The research, led by Dr. Sanjay Chawla of the Children's Hospital of Michigan and published in JAMA Network Open, analyzed outcomes for 1,806 preterm infants born between 22 and 26 weeks of gestation. The study specifically examined 1,331 infants exposed to a single dose of betamethasone within 24 hours of birth, compared to 475 unexposed infants.
Progressive Benefits with Each Hour
The findings revealed a clear time-dependent benefit: for every hour between betamethasone administration and birth, researchers observed a 1% increase in both survival rates and survival without illness. This progressive improvement demonstrates the rapid impact of the medication on fetal development, even in cases where the standard full course cannot be completed.
Current Treatment Protocol and New Insights
Standard protocol for antenatal steroid treatment typically involves either two doses of betamethasone 24 hours apart or four doses of dexamethasone administered at 12-hour intervals. These treatments are known to accelerate fetal lung maturation and reduce various complications, including:
- Newborn mortality
- Respiratory complications
- Intestinal issues
- Intracranial hemorrhage
Clinical Implications for Emergency Situations
"These findings support a proactive approach to administering betamethasone when preterm birth is imminent," notes Dr. Chawla. The research provides crucial evidence for healthcare providers facing emergency delivery situations, suggesting that even partial treatment can yield significant benefits.
Impact on Clinical Practice
This research challenges previous uncertainties about the minimum effective duration of antenatal steroid treatment. While complete courses remain optimal, the study provides strong evidence supporting immediate steroid administration in cases where preterm delivery appears inevitable, regardless of whether the full treatment course can be completed.
The results particularly impact clinical decision-making in emergency situations, where healthcare providers previously might have hesitated to initiate steroid treatment if they believed there wasn't sufficient time for a complete course.
