Kristin J McLaughlin1, Caroline A Crowther. 1. Department of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia. kristin.mclaughlin@adelaide.edu.au
Abstract
BACKGROUND: Repeat prenatal corticosteroids have been in common use worldwide, even though the National Institutes of Health recommends that 'Until data establish a favourable benefit-to-risk ratio, repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.' OBJECTIVES: To describe the current use/recommendations for the use of repeat prenatal corticosteroids by obstetricians and neonatologists and to examine the sources of evidence on which their practice is based. DESIGN: Postal questionnaire. POPULATION: All Trainees, Members and Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and neonatologists in Australia and New Zealand. METHODS: The questionnaire was mailed to obstetricians and neonatologists in August-September 2001. MAIN OUTCOME MEASURES: Practitioner use/recommendations for the use of repeat prenatal corticosteroids and the sources of evidence on which their practice was based. RESULTS: Use of repeat prenatal corticosteroids was recommended by 332 (44%) obstetricians and 19 (21%) neonatologists. Obstetricians were twice as likely to recommend their use compared with neonatologists (relative risk, 2.04; 95% confidence intervals, 1.36-3.06; P < 0.001). Over half of the respondents (483, 57%) reported they had changed their use/recommendations in the previous 3 years. The sources of evidence behind these practices differed between obstetricians and neonatologists and between those practitioners who recommended the use of repeat prenatal corticosteroids and those who did not. CONCLUSIONS: Fewer practitioners recommend repeat prenatal corticosteroids compared with previous surveys. Sources of evidence behind the practice of groups of obstetricians and neonatologists differ.
BACKGROUND: Repeat prenatal corticosteroids have been in common use worldwide, even though the National Institutes of Health recommends that 'Until data establish a favourable benefit-to-risk ratio, repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.' OBJECTIVES: To describe the current use/recommendations for the use of repeat prenatal corticosteroids by obstetricians and neonatologists and to examine the sources of evidence on which their practice is based. DESIGN: Postal questionnaire. POPULATION: All Trainees, Members and Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and neonatologists in Australia and New Zealand. METHODS: The questionnaire was mailed to obstetricians and neonatologists in August-September 2001. MAIN OUTCOME MEASURES: Practitioner use/recommendations for the use of repeat prenatal corticosteroids and the sources of evidence on which their practice was based. RESULTS: Use of repeat prenatal corticosteroids was recommended by 332 (44%) obstetricians and 19 (21%) neonatologists. Obstetricians were twice as likely to recommend their use compared with neonatologists (relative risk, 2.04; 95% confidence intervals, 1.36-3.06; P < 0.001). Over half of the respondents (483, 57%) reported they had changed their use/recommendations in the previous 3 years. The sources of evidence behind these practices differed between obstetricians and neonatologists and between those practitioners who recommended the use of repeat prenatal corticosteroids and those who did not. CONCLUSIONS: Fewer practitioners recommend repeat prenatal corticosteroids compared with previous surveys. Sources of evidence behind the practice of groups of obstetricians and neonatologists differ.
Authors: L F J Mildenhall; M R Battin; S M B Morton; C Bevan; C A Kuschel; J E Harding Journal: Arch Dis Child Fetal Neonatal Ed Date: 2005-09-20 Impact factor: 5.747