Use of antenatal corticosteroids for fetal maturation in preterm infants.

Respiratory distress syndrome is the most common complication in preterm infants and is a significant cause of death and severe morbidity. In 1994, a National Institutes of Health (NIH) consensus panel evaluated the strength of the scientific evidence regarding the use of prenatal corticosteroids for fetal maturation in preterm infants. The NIH panel's recommendations include the use of corticosteroid therapy for delivery anticipated before 34 weeks of gestation when the fetal membranes are intact and before 32 weeks of gestation when the membranes are ruptured. The beneficial effects of corticosteroid administration are greatest if more than 24 hours and less than seven days have elapsed between initial administration of therapy and actual delivery. An important secondary benefit of corticosteroid administration is the reduction in the cost and duration of neonatal hospitalization. Presently, corticosteroids are used in less than 20 percent of eligible patients. This trend will likely be viewed as an unacceptable deviation from appropriate standard of care. Prenatal orientation programs should educate pregnant women about early recognition of conditions that are likely to result in preterm birth. This approach would help ensure early presentation and commencement of treatment.