The research in the 7 December issue of the Journal of the American Medical Association suggests that preterm babies may benefit sooner than thought from the boost in lung power and organ growth they get from exposure to steroids.
Until now, little was known about the efficacy of giving a pregnant woman steroids for a fetus less than 24 weeks old, and some were worried it could raise the risk of infection in the mother.
Current guidelines, published in 1995, recommend a two-shot regimen for mothers who go into preterm labor when the fetus is between 24 and 34 weeks of age. A normal full-term pregnancy is between 37 and 42 weeks.
However, even though premature babies exposed to steroids were twice as likely to survive as those who were not, the researchers cautioned that overall survival still remained relatively low, at 36%.
To determine if steroids could help the youngest babies survive after being born on the edge of viability, doctor Waldemar Carlo of the University of Alabama at Birmingham and colleagues looked back at records between 1993 and 2009 at 23 academic perinatal centers in the United States.
Data included babies born between 401 grams (14.1 ounces) and 1,000 grams (35.3 ounces) at 22 to 25 weeks' gestation.
Among babies born at 23 weeks who were exposed to steroids, 83% either died or had brain development problems by age 18-22 months.
90% of those who weren't given steroids either died or showed brain damage.
The same advantages were not seen at a statistically significant level in babies aged 22 weeks who were exposed to steroids.
The improvements were more pronounced in babies aged 24 weeks, 68% of whom died or had brain damage after getting steroids compared to 80.3% who did not.
Concerns about potential infection in pregnant mothers, whose immune systems would dip after being given the steroids, were unfounded, he said.
"The results of the study showed that mortality was decreased by more than 33% and neurodevelopmental impairment was decreased by more than 20%," Carlo said.
"We also found that using the antenatal corticosteroids did not increase the infection rate for the mothers."
Carlo and colleagues urged further research and said doctors should consider giving preterm mothers steroids starting at "23 weeks' gestation and later if the infant will be given intensive care because this therapy is associated with reduced mortality and morbidity."
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