Rescue corticosteroids in twin pregnancies and short‐term neonatal outcomes

Abstract

Objective To estimate the efficacy of a rescue course of antenatal corticosteroids in twin pregnancies.Design Retrospective cohort study.Setting Tertiary-care centre.Population Twins born from 24 to <34 weeks of gestation in a single maternal and fetal medicine practice from 2006 to 2011.Methods We compared neonatal outcomes in 88 twins exposed to a single course of corticosteroids with outcomes in 42 twins exposed to two courses of corticosteroids: the initial course and a single rescue course. Analyses were adjusted to control for correlation between twins born to the same mother.Main outcome measure Short-term neonatal respiratory morbidity.Results Rescue corticosteroids were associated with fewer days of mechanical ventilation (7.3 ± 3.3 versus 33.9 ± 25.3 days, P = 0.003), fewer days with a fraction of inspired oxygen of >21% (6.3 ± 4.3 versus 33.3 ± 25.8 days, P = 0.003), a lower incidence of mechanical ventilation >14 days or death while on mechanical ventilation (0 versus 12.5%, P = 0.016), and a lower incidence of retinopathy of prematurity (0 versus 12.5%, P = 0.016). The proportion of neonates with respiratory distress syndrome did not differ between the groups (adjusted odds ratio 1.28, 95% confidence interval 0.50-3.26). There were no differences found for birthweight, head circumference and length.Conclusions In twins born before 34 weeks of gestation, exposure to rescue corticosteroids may be associated with improved neonatal outcomes. Further studies are warranted to assess the effect of rescue corticosteroids in twin pregnancies.

The role of antenatal corticosteroids in twin pregnancy

“…And there were no significant differences in treatment effects among the subgroups by the number of fetuses in utero. As for twins, a rescue ACS course was associated with a lower rate of RDS, surfactant use, and BPD, while no differences were noted in neonatal birthweight, head circumference, and the rate of neonatal hypoglycemia (Zigron et al, 2022), which was supported by another retrospective study (Bibbo et al, 2013). But the results of these studies above may be limited by retrospective design and small sample size.…”

Relation between time interval from antenatal corticosteroids administration to delivery and neonatal outcome in twins

“…Similar findings were published by other authors . As the prophylactic ACS administration strategy is not effective in twins, it is prudent not do administer corticosteroids until the delivery is actually imminent in order to maximize the benefit …”

“…18,24 As the prophylactic ACS administration strategy is not effective in twins, it is prudent not do administer corticosteroids until the delivery is actually imminent in order to maximize the benefit. 18,24 Our study is limited by its retrospective nature, a small sample size and selected study group. It is probably underpowered, because the sample size was not enough to detect all significant differences, especially with stratification to gestational age.…”

Corticoides antenatales y prevención del distrés respiratorio del recién nacido prematuro: utilidad de la terapia de rescate

“…Otra controversia es la utilización de un ciclo único o repetido de corticoides, en aquellas mujeres que ya han recibido un ciclo completo y en las que persiste la amenaza de parto prematuro. Los ensayos clínicos aleatorizados arrojan resultados contradictorios, unos apoyan la administración de dosis de rescate puesto que encuentran una reducción de la morbilidad neonatal 7,8 , mientras otros no objetivan mejoría en el pronóstico de los RNPT expuestos a dosis repetidas de corticoides antenatales 9,10 .…”