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Authors
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Professor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TXGeorge Saade, MD
Professor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TXProfessor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TX
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Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical CenterCynthia Gyamfi-Bannerman, MD, MSc
Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical CenterEllen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical Center
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Director of the Prenatal Genetic Screening Program, UCSFMary Norton, MD
Director of the Prenatal Genetic Screening Program, UCSFDirector of the Prenatal Genetic Screening Program, UCSF
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Experts
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Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolSarah Little, MD, MPH
Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolAssistant Professor of Obstetrics and Gynecology at Harvard Medical School
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Professor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of UtahBradley Yoder, MD
Professor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of UtahProfessor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of Utah
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Chief of Obstetrics at Brigham HealthJulian Robinson, MD
Chief of Obstetrics at Brigham HealthChief of Obstetrics at Brigham Health
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Professor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical CenterRonald Wapner, MD
Professor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical CenterProfessor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical Center
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Associate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of MedicinePradeep Mally, MD, Dch, FAAP
Associate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of MedicineAssociate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of Medicine
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Head of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai HospitalKellie Murphy, MD, MSc, FRCSC, DACOG
Head of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai HospitalHead of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai Hospital
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Professor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of NeonatologyCindy McEvoy, MD, MCR
Professor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of NeonatologyProfessor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of Neonatology
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Professor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San FranciscoMari-Paule Thiet, MD
Professor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San FranciscoProfessor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San Francisco
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Neonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of TorontoElizabeth Asztalos, MD
Neonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of TorontoNeonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of Toronto
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Associate Professor, Department of Obstetrics and Gynecology at McMaster UniversitySarah McDonald, MD
Associate Professor, Department of Obstetrics and Gynecology at McMaster UniversityAssociate Professor, Department of Obstetrics and Gynecology at McMaster University
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Moderators
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Resident Physician at Brigham HealthRachel Pilliod, MD
Resident Physician at Brigham HealthResident Physician at Brigham Health
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Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.Molly Siegel, MD
Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.
About the Discussion
@NEJM Ask the Authors & Experts: Antenatal Corticosteroids for Women at Risk of Late Preterm Delivery
Original Article
Antenatal Corticosteroids for Women at Risk of Late Preterm Delivery
Cynthia Gyamfi-Bannerman, M.D., M.Sc.; Elizabeth A. Thom, Ph.D.; Sean C. Blackwell, M.D.; Alan T.N. Tita, M.D., Ph.D.; Uma M. Reddy, M.D., M.P.H.; George R. Saade, M.D.; Dwight J. Rouse, M.D.; David S. McKenna, M.D.; Erin A.S. Clark, M.D.; John M. Thorp, Jr., M.D.; Edward K. Chien, M.D., M.B.A.; Alan M. Peaceman, M.D.; Ronald S. Gibbs, M.D.; Geeta K. Swamy, M.D.; Mary E. Norton, M.D.; Brian M. Casey, M.D.; Steve N. Caritis, M.D.; Jorge E. Tolosa, M.D., M.S.C.E.; Yoram Sorokin, M.D.; J. Peter VanDorsten, M.D.; and Lucky Jain, M.D., M.B.A., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
N Engl J Med 2016; 374: | April 4, 2016 | DOI:10.1056/
BACKGROUND
Infants born at 34 to 36 weeks’ gestation (late preterm) have greater risks of adverse respiratory and other outcomes, than those born at 37 weeks gestation or later. It is not known whether betamethasone administered to women at risk for late preterm delivery decreases risks of neonatal morbidities.
METHODS
We conducted a multicenter randomized trial of women with a singleton gestation at 34 weeks 0 days to 36 weeks 5 days gestation and at high risk for late preterm delivery. Participants were randomized to two injections of betamethasone or matching placebo 24 hours apart. The primary outcome was a neonatal composite of treatment in the first 72 hours (continuous positive airway pressure or high flow nasal cannula for at least two hours, supplemental oxygen with a fraction of inspired oxygen of at least 30 percent for at least four hours, extra corporeal membrane oxygenation or mechanical ventilation) or stillbirth or neonatal death before 72 hours.
RESULTS
2,831 patients were randomized. The primary outcome occurred in 11.6% (165/1427) of the betamethasone group versus 14.4% (202/1400), in the placebo group (Relative Risk 0.80, 95% confidence interval 0.66-0.97, P=0.02). Severe respiratory morbidity, transient tachypnea of the newborn, surfactant use, and bronchopulmonary dysplasia were also significantly less common in the betamethasone group. There were no significant differences between groups in the incidence of chorioamnionitis or neonatal sepsis. Neonatal hypoglycemia was more common in the betamethasone group (24.0% versus 15.0%, RR 1.60, 95% CI 1.37-1.87, P<0.001).
CONCLUSIONS
Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory morbidity. (Funded by the NICHD; ClinicalTrials.gov number NCT01222247.)
Originally Appeared in The New England Journal of Medicine on April 4, 2016.
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Authors
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Professor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TXGeorge Saade, MD
Professor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TX
Professor of Obstetrics and Gynecology, Professor of Cell Biology, Director of Perinatal Research Division, Chief of Obstetrics and Maternal Fetal Medicine, Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at University of Texas Medical Branch- Galveston TX
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Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical CenterCynthia Gyamfi-Bannerman, MD, MSc
Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical Center
Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women's Health in Obstetrics and Gynecology, Maternal-Fetal Medicine, Director, Maternal-Fetal Medicine Fellowship Program, Alternate PI, Maternal-Fetal Medicine Units Network at Columbia University Medical Center
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Director of the Prenatal Genetic Screening Program, UCSFMary Norton, MD
Director of the Prenatal Genetic Screening Program, UCSF
Director of the Prenatal Genetic Screening Program, UCSF
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Experts
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Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolSarah Little, MD, MPH
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
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Professor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of UtahBradley Yoder, MD
Professor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of Utah
Professor of Pediatrics, Division of Neonatology, Medical Director of NICU at University of Utah
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Chief of Obstetrics at Brigham HealthJulian Robinson, MD
Chief of Obstetrics at Brigham Health
Chief of Obstetrics at Brigham Health
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Professor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical CenterRonald Wapner, MD
Professor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical Center
Professor of OBGYN, Vice Chair of Research, Director of Reproductive Genetics at Columbia University Medical Center
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Associate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of MedicinePradeep Mally, MD, Dch, FAAP
Associate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of Medicine
Associate Professor of Pediatrics, Chief of Division of Neonatology, Director of Neonatal-Perinatal Fellowship Program at New York University School of Medicine
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Head of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai HospitalKellie Murphy, MD, MSc, FRCSC, DACOG
Head of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai Hospital
Head of Research, Associate Professor, Department of Obstetrics adn Gynaecology at University of Toronto, Mount Sinai Hospital
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Professor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of NeonatologyCindy McEvoy, MD, MCR
Professor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of Neonatology
Professor of Pediatrics, Director of Clinical Research for Pediatric and Child Health Research Program, Director of Research for Division of Neonatology
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Professor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San FranciscoMari-Paule Thiet, MD
Professor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San Francisco
Professor, Russell K Laros, Jr, MD Endowed Chair, Director of the Division of Maternal-Fetal Medicine, Chief of Obstetrics at University of California at San Francisco
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Neonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of TorontoElizabeth Asztalos, MD
Neonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of Toronto
Neonatologist, Associate Professor of Pediatrics and Obstetrics and Gynecology at Sunnybrook Health Sciences Centre, University of Toronto
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Associate Professor, Department of Obstetrics and Gynecology at McMaster UniversitySarah McDonald, MD
Associate Professor, Department of Obstetrics and Gynecology at McMaster University
Associate Professor, Department of Obstetrics and Gynecology at McMaster University
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Moderators
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Resident Physician at Brigham HealthRachel Pilliod, MD
Resident Physician at Brigham Health
Resident Physician at Brigham Health
-
Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.Molly Siegel, MD
Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.
Obstetrics and Gynecology Resident at University of California, San Francisco. Interested in quality improvement and care for the underserved.
