A review of the use of antenatal steroids at the Rotunda Hospital

SummaryThere is ample evidence for the efficacy and safety of antenatal steroids in the acceleration of lung maturation, with a 40 per cent reduction in mortality and a corresponding reduction in the incidence of respiratory distress syndrome and intraventricular haemorrhage. It is now recommended that all fetuses between 24 and 34 weeks gestation, threatened with premature delivery should receive antenatal steroids. Despite this the reported use of antenatal steroids in many studies remains disappointingly low. Our objectives in this study were to review the use of antenatal steroids at the Rotunda Hospital over a recent 2-year period, and to identify whether all eligible infants were treated appropriately. The charts of 250 mothers who delivered before 35 completed weeks pregnant between 1 January 1993 and 31 December 1994 and whose infants were admitted to the neonatal intensive care unit were reviewed retrospectively. There were 303 infants delivered to the 250 women during the study period. Of the 129 women who were hospitalised for more than 24 hours prior to delivery, 80 per cent received a full course of dexamethasone. Eighty-five per cent of those less than 30 weeks and 77 per cent of those 30 to 35 weeks received a full course. Excluding those over 34 weeks, 86 per cent received a full course. Of the group hospitalised for over 24 hours, 10 per cent received no steroids. All but one patient had a reasonable explanation for the withholding of steroids. A further 19 per cent of patients received a partial course. Of the 121 women who were hospitalised for less than 24 hours, 48 per cent received a partial course of steroids. Of these 121 women, only 56 were in hospital for more than 4 hours prior to delivery and of these 69 per cent received a partial course. The overall use of steroids either as a complete or partial course was 70 per cent.We conclude that in the Rotunda Hospital, steroid use in the antenatal population threatened with premature labour conforms to a high standard of care. This is a result of a policy of promotion of awareness of antenatal steroids among the house staff in the hospital.