101: Antenatal corticosteroids in IUGR–are we getting it right?

The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The use of corticosteroids to promote fetal lung maturation is well established in clinical practice with the optimal timing of administration between 48 hours and 7 days of delivery. The objective of this analysis was to investigate the appropriate use and effectiveness of steroid administration in the PORTO cohort. Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFW<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment until birth. Adverse perinatal outcome was defined as composite outcome of IVH, PVL, HIE, NEC, BPD, sepsis or death. The appropriate use and effectiveness of corticosteroids was analyzed. Of the 1,116 fetuses <10th centile, 512 (46%) received antenatal corticosteroids at a mean GA of 31 weeks and subsequently delivered at a mean GA of 36 weeks. 305 (60%) were administered steroids within one week of IUGR diagnosis; this strongly correlated with the severity of IUGR (EFW consistently <10th centile, p-value <0.0001). 402 (79%) received steroids prior to 34 weeks gestation while 110 (21%) were given steroids on or after 34 weeks. Only 64 (13%) were administered steroids within 7 days of delivery. Betamethasone was the steroid of choice in 196 (38%) cases and 316 (62%) received dexamethasone. There were slightly fewer adverse outcomes in the betamethasone group compared to the dexamethasone group (8.7% versus 10.1%, p=0.5869). However, those given betamethasone were more likely to be admitted to NICU (52% versus 39%, p=0.0065). Our data show that only 13% of IUGR fetuses received antenatal corticosteroids at the optimal and most effective timing in relation to delivery. Consideration should be given to deferring steroid administration until delivery is likely rather than the empirical administration at IUGR diagnosis.