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Help for Preemies Is One-Shot Deal

No need for multiple steroid injections to prevent illness, says study

TUESDAY, Oct. 2, 2001 (HealthDayNews) -- A single injection of hormones late in pregnancy is enough to reduce the incidence of illness and death for premature babies, a study finds.

Gynecologists have been giving injections of corticosteroid hormones to women at high risk of premature delivery for several years to prevent serious respiratory problems and brain hemorrhages in their babies. Many have been giving weekly shots to be sure the treatment is effective. Now a study at 13 medical centers finds no advantage and some possible risk for multiple shots.

"We found from our results that there is no obvious benefit from a weekly course of corticosteroids," says lead study author Dr. Debra A. Guinn, assistant professor of obstetrics and gynecology at the University of Colorado Health Sciences Center in Denver. "There were also definite signs of potential risk to the babies from multiple injections." The findings appear in the latest issue of The Journal of the American Medical Association.

The major complications of premature birth include respiratory distress syndrome, a severe breathing problem, and bleeding in the brain. "Our study found that a single course of corticosteroid treatment can reduce respiratory distress, bleeding in the brain and death by as much as 50 percent," Guinn says.

The study included 501 pregnant women who showed signs of premature delivery, such as contractions as early as the 24th week or early rupture of membranes. All were given a single injection of a corticosteroid, either betamethasone or dexamethasone. Half also got weekly injections until their 34th week or delivery, while the other half got harmless, inactive injections weekly.

Looking at all the problems that face preemies -- brain damage, respiratory trouble, infections, intestinal inflammation -- the researchers found no statistically significant difference in the babies born to mothers who got a single dose of a drug and those who got the weekly doses. Multiple shots did decrease the incidence of respiratory distress syndrome, but did not decrease hospitalizations and deaths caused by the condition.

Though an increased incidence of problems such as infections of the amniotic fluid associated with the multiple injections were not statistically significant, they were enough to cut the study short, the researchers say.

The study provides solid evidence to support the finding of a National Institutes of Health consensus statement advising single-dose steroid treatment in prematurity, says Dr. Joanne Stone, associate professor of obstetrics and gynecology at Mount Sinai School of medicine in New York City and a member of the study team.

"The problem has been that up until this study, there has not been a definitive study that addressed that issue," Stone says. "For a long time, no one was giving steroids, then everyone was giving them weekly. Then there were worries, which is why this study was done."

The finding could affect the health of tens of thousands of babies each year, since one of every 10 infants in the United States is born prematurely.

What To Do

"Our data strongly suggest that weekly courses of antenatal corticosteroids should not be prescribed routinely for women at risk of preterm delivery," the researchers say.

For information about managing preemies, go to the American Association for Premature Infants or Parents of Premature Babies, Inc., for a list of resources.

SOURCES: Interviews with Debra A. Guinn, M.D., assistant professor of obstetrics and gynecology, University of Colorado Health Sciences Center, Denver, Joanne Stone, M.D., associate professor of obstetrics and gynecology, Mount Sinai Medical Center, New York City; Oct. 3, 2001, The Journal of the American Medical Association
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