Antenatal steroids—given to expectant mothers at risk for early delivery—can improve a preterm infant’s survival odds even if they are given only hours before birth, suggests a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). For maximum fetal lung maturation, an at-risk pregnant woman should receive two or four steroid doses within 48 hours before delivery. The findings provide evidence that, even if preterm birth is imminent, one dose of treatment is still beneficial.
The study was conducted by Sanjay Chawla, M.D., of the Children’s Hospital of Michigan and colleagues in the NICHD Neonatal Research Network. It appears in JAMA Network Open.
Background
Giving antenatal steroids to pregnant women at risk for preterm delivery speeds fetal lung development and can reduce the chances of newborn death, breathing and intestinal complications, and bleeding inside the brain. The steroid betamethasone is given in two doses, 24 hours apart, and the steroid dexamethasone is given in four doses, 12 hours apart. However, many preterm infants are born before a full course of steroids can be given. Although partial doses of antenatal steroids are associated with improved infant outcomes, there is insufficient data about how much time must pass between a steroid dose and birth before benefits to an infant’s health are observed.
Results
For the current study, researchers analyzed records of 1,806 preterm infants born from 22 to 26 weeks of pregnancy. Of these, 1,331 were exposed to a single dose of betamethasone within 24 hours of birth, and 475 were unexposed.
Infants born after exposure to a single dose of antenatal betamethasone had a 1% increase in survival, as well as a 1% increase in survival without illness, for every hour that passed between administration of the drug and birth.
Significance
The authors concluded that for women at risk of preterm birth, a single dose of antenatal betamethasone is associated with significant benefits, and these benefits increase as more time passes between an initial dose and birth. The authors added that their findings support a proactive approach to administering betamethasone when a preterm birth is imminent.
Reference
Chawla SA, et al. Short duration of antenatal corticosteroid exposure and outcomes in extremely preterm infants. JAMA Network Open DOI:10.1001/Jamanetworkopen.2024.61312 (2025)
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