Does the time from corticosteroid dosing to delivery affect neonatal outcome

Objective: To determine if the timing of steroid dosing affects neonatal morbidity and mortality. Methods: This was a retrospective cohort study. Women who had codes associated with preterm delivery from 2003 through 2007 were identified. Those with anomalous fetuses or non-standard steroid dosing were excluded. The maternal and neonatal charts were reviewed for clinical and demographic data. Relative risks were determined for respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), mortality, and compound morbidity/mortality. Results: The sample included 159 neonates born to 128 women. The patients were divided by elapsed time from steroids to delivery. There were no significant differences between the groups in regards to gestational age or demographics. The odds ratios for RDS, IVH, NEC, mortality and compound morbidity/mortality were calculated using multivariate stepwise logistic regression. When compared to those who delivered 1-7 days after their first dose of steroid, the OR for RDS was 32.9 (95% CI 2.21-490) for those who delivered 0-24 hours and 7.31 (95% CI 1.61-33.3) for those who delivered more than 7 days after their first dose of steroids. There was a reduction in risk of NEC (OR 0.15 95% CI 0.025-0.99) for the neonates that delivered more than 7 days after steroids. The time from dose to delivery was not significant for the outcomes of IVH, composite morbidity and mortality or mortality. Conclusion: The best therapeutic window for reducing RDS is 24 hours to 7 days after the first dose of steroids. Other important determinants of neonatal outcome are the gestational age at delivery, birth weight, gender, presence of chorioamnionitis or funicitis.