The Effect of Betamethasone Dosing Interval on Perinatal Outcomes: 12 Hours or 24 Hours Apart

Abstract

Objective Antenatal steroids are commonly used to stimulate fetal lung maturation, particularly in pregnancies at risk of early preterm labor. This study aimed to compare the effects of administering betamethasone at a 12- versus 24-hour interval on perinatal outcomes. Study Design This retrospective study included 423 early preterm births from 26+0/7 to 33+6/7 weeks of gestation. Patients received betamethasone at either a 12- or 24-hour dosing interval. Results When all patients in each group were evaluated together, there was no statistically significant difference between both groups for complications of prematurity, including respiratory distress syndrome (RDS). When the two groups were divided by gestational age (GA), the 32+0/7 to 33+6/7-week group that received betamethasone at a 24-hour interval had statistically lower 1- and 5-minute APGAR scores (p = 0.06 and p = 0.02, respectively). They also had a greater need for neonatal intensive care unit (NICU), NICU length of stay, RDS, and need for surfactant (p = 0.20, p = 0.09, p = 0.27, and p = 0.23, respectively) than did the infants at 32+0/7 to 33+6/7 weeks, who received betamethasone at a 12-hour interval. In the group with GA between 28+0/7 and 29+6/7 weeks, the 1-minute APGAR score was lower (p = 0.22), and the durations of hospital stay, and mechanical ventilation were longer (p = 0.048, p = 0.21, respectively) in the 24-hour interval group. No statistically significant difference was observed for all parameters in other GA groups. Conclusion A 12-hour dosing interval for betamethasone appears to be more appropriate, as it results in a reduction in some neonatal complications and provides a short dose interval. Key Points

Antenatal Betamethasone dosing schedule: an ongoing conundrum!

“…A recent study by Bulut et al demonstrated significant benefit of 12 hourly dosing interval in neonates born between 32+0/7 and 33+6/7 weeks gestation in the form of higher Apgar scores, reduced length of neonatal intensive care stay, and reduced respiratory distress syndrome and surfactant instillation. 2 In the neonates born between 28+0/7 and 29+6/7 weeks who received 12 hourly regimen, there was shorter duration of mechanical ventilation and hospital stay, which is probably due to the decreased severity of neonatal morbidities. The potential benefit with the 12 hourly regime for respiratory distress syndrome has also been described by Kashanian et al in their randomised control trial of 201 women delivering between 26-34 weeks.…”